Talk, Talk, Talk Speeds Bipolar Recovery

Action Points

Explain to interested patients that this study shows that intensive psychotherapy -- in any of three forms -- helps speed the recovery from depression for patients with bipolar disorder.

BOULDER, Colo., April 2 -- Intensive psychotherapy, coupled with medication, speeds recovery from depression for patients with bipolar disorder, according to researchers here.

In a randomized trial, depressed bipolar patients getting any of three forms of intensive psychotherapy recovered more rapidly than those given a brief, three-session intervention, found David Miklowitz, Ph.D., of the University of Colorado, and colleagues, reported in the April issue of the Archives of General Psychiatry.

At the end of a year more of the patients getting the intensive therapy had recovered, compared with those given only the brief intervention, said Dr. Miklowitz and colleagues.

"Intensive psychotherapy, when used as an adjunctive treatment to medication, can significantly enhance a person's chances for recovering from depression and staying healthy over the long term," Dr. Miklowitz said.

"It should be considered a vital part of the effort to treat bipolar illness," he added.

The finding came from the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) collaboration, which is examining a range of therapies for the disorder.

They were randomly assigned to one of four psychotherapeutic interventions:

Collaborative care, the control arm, in which they were given a videotape and a workbook about aspects of bipolar disorder. Three 50-minute sessions with a therapist were devoted to review of the materials.

Cognitive behavioral therapy, which focused on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness.

Interpersonal and social rhythm therapy, which focused on establishing and maintaining stable social rhythms, such as eating, sleeping, and exercising.

Family-focused therapy, in which patients ands relatives were helped to understand what caused depressive episodes and how relapses might be prevented.

All intensive therapy arms included up to 30- to 50-minute sessions over nine months.

The researchers found that 172 of the 293 patients had recovered from the depression by the end of the study year, while 121 either did not recover or dropped out before recovery could be determined.

The one-year recovery rate was 64.4% in the intensive therapy group, compared with 51.5% in the control arm, a difference that was statistically significant at P=0.01. Patients getting intensive therapy were 47% more likely to have recovered, with a hazard ratio for recovery of 1.47 (and a 95% confidence interval from 1.08 to 2.00).

The median time to recovery (among patients who recovered) was 113 days in the intensive group and 146 days in the control arm. In a multivariate analysis, the hazard ratio was 1.53, which was statistically significant at P=0.009.

At any given month during the study, patients in intensive therapy were 1.58 times more likely to be clinically well than those in the collaborative care arm. With a 95% confidence interval from 1.17 to 2.13, the finding was significant at P=0.003.

There were no significant differences in the outcomes of the three intensive therapies, the researchers said, possibly because the study was underpowered to detect them.

In this study, patients entered relatively early in their depressive episode and may be more representative of a general clinical practice than those usually enrolled in clinical trials, the researchers said.

An issue to be explored in future studies, they noted, is the cost-effectiveness of therapy. While this study shows that intensive psychotherapy is more effective, it is also more costly, Dr. Miklowitz and colleagues said.

The research was supported by the National Institute of Mental Health and by the National Alliance for Research on Schizophrenia and Depression. One of the authors, Andrew A. Nierenberg, M.D., of Harvard Medical School in Boston, has been a consultant to or received grants and/or honoraria from Bristol-Myers Squibb, Genaissance, GlaxoSmithKline, Innapharma, Janssen, Eli Lilly, Novartis, Pfizer, Sepracor, Shire, Somerset, Sumitomo, Cedexroth, Cyberonics, Forest, Lichtwer, and Wyeth. No other potential conflicts were reported.

Reviewed by Zalman S. Agus, MD Emeritus Professor at the University of Pennsylvania School of Medicine

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